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1 3 Permit No. ."�._.....----•- -- �' APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued This Permit Ex ices 1 Year From Date Issued Cal HealW District for a permit to construct and install the work Application is hereby made to the Son Joaquinherein described.This applicatiori is made in compliance with County Stockt m......••--•---• ••---•......•--••...._.....•••-----•--- � Mariposa-_Road---•-------- ---------------------- JOB ADDRESS AND LOCATION-=------� 8---• Phone__..... r Crane Ser ice Clow s .. _8.._.. e...- ------------- Owner's Name------...PD_.-..__.....QN .........••..••..•.. -- 1 • ---••----..... Phone.--•--...------�•----•- Contractor's Name._.-_The..D.�X__.c�.-N��xHT---Sevt g-_T_ank-•Se�'y�c�_........•--""- M.. P Other ❑ Trailer Court ❑ ❑ Installation will serve: Residence ® Apartment House ❑' Commercial ❑ Motel " _•.............................. 1 Number of living units: .. �- Number of bedrooms...2.. Number of baths _-_...._ Lot size _._. -----•-- Dth to Water Table _50.1 ft. } Water Supply: Public system ❑ Community system t-] Private Z( P Sand Loam❑ Clay Loam [] Clay [3Adobe aHardpan❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel 171.. y No Cf pHA/VA:Yes ❑ No El Application Made: Yes [3 No ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or permitted if public sewer is avai{able within 200 feet.} Material................................... a -• 04 - Septic Tank: Dlsfsnce from nearest wall----- from fou- afi1q Liquid depth.........................Capacity----------...•--------- E®isting No. of compartments_..-_-------------.;.--.Size__. ....._...-.. Is oral Field: Distance from nearest well.--.r1L1�••`-•-Distance from foundation....��.••--•---Distance to nearest lot line-5Q,_"_.....• Disposal E sting Number of lines---.--1- ••-------••Length of each line__------ -��-�i Width ofgrench......-------•..------- �k..Dopth of filter material----I- .-----------Total length-.... ..................•-_--•-• & Add Type of filter material_.S.£?p..=•• linet �Q�:___,_...Distar;�e to nearest lot ._.....0---.•- Seepage Pit: Distance to nearest well-.--_100t..•---•Distance from foundation... �� De th_._...2.5..... ""-""•----- i Number of pit•s.�_-•---- ----Lining material__.RQek._....Size: Diameter._...... P Distance from nearest well.................D•istanze from foundation............. •••.Li Lining uid material e "-----_------- _-- -- -- 905- Size: ..•... q ........................... ❑ Size: Diameter-----------------•-...-...... Depth \ 9 -- •------------------- Privy: •--- C Privy: Distance from nearest well...--..--"•--•-'" ......--"-. Distance from nearest buildin - ❑ Distance to nearest lot line---------.---..•---••-- -----•---_-••---•--------------- " •---•-••-•-•-•-•.......................... Remodeling and/or repairing (describe)%...... .._._... "•----•. •---.....__..... . ••---• ...._.._. a I ----.--" - ----------- -----_----_---__ --------•----------------•----"" .............-•--- --'- ------ """-'"-'-"--"---•" application and that the work will be done in accordance with San Joaquin County I hereby certify.that l have prepared this app ordinances, State laws, and rules and regulations of the San Joe in L cal Health istrict, a Contractor) (Signed).. k1e.•_I�Ay _OU ...S.ep-t3_G...`�'aI�k_a.s�' --ice... - "• -•-----------•.............. ---•- ----------- _ (Title}_ ........ BY�--------------------------------------------------------------- --•--•--------•---•------------------•--------•------• ---..._ �s etc can be plat on reverse side). (Plot plan, showing size of lot, location of system in relation to we[ ui 9 —� FOR DEPART,,ENT USE ONLY , ---------------•. DATE---- .�t�.. ------------------ APPLICATION ACCEPTED BY- ._•_•--.... ► ............ DATE...........-...------------------------------ ---------- ......--•--•--.....--•--------------------•- ••--- REVIEWEDBY--------------------------------................_..----- •- ......----------- BUILDING PERMIT ISSUED----_--------------...........-._..•.............. -------------- ........... Alterations and/or recommendations--_--------.-"_._._..."-.._. •..............•____........ „ .r`� .-...-----•"-•-----•-•-••----•-------••----- •----- ------_.................•• .........- ........_.. 7��..i 1 _.. ......... ................................... ........ ...... ......... FINAL INSPECTION ------------- -"...........-.-... ._... ............ Date_.., � f�..... -•••................... ------_.... SAN JOAQUIN LOCAL HEALTH DISTRICT 300 r 814 North "C" Street Oak Street 132 Sycamore Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California Manteca. Revised a'59 r.p.co. .� —